Patients who receive palliative care in a hospital often have trouble finding a provider to continue those services after they return home.
The number of hospitals that offer palliative care has grown exponentially during the past two decades. As of 2020, more than 83% of U.S. hospitals with 50 or more beds had a palliative program, up from 25% in 2000, according to the Center to Advance Palliative Care (CAPC).
Despite this growth, many hospitalized patients who could benefit from palliative care do not receive it. Moreover, continuity of palliative care is often disrupted when the patient returns to the community, according to Rory Farrand, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization (NHPCO).
“Over 1,400 hospitals in our country have a palliative care service. But then what happens is that we see patients in a hospital, and then they get discharged into the ether. There are a lot of challenges when you’re trying to follow patients into the community,” Farrand said at the 2023 Hospice News Palliative Care Conference. “People are asking for palliative care, but we just don’t have the opportunity sometimes in certain communities — rural communities, underserved communities — to deliver care where people want it and need it, in the home.”
Though the community-based palliative care space is gradually diversifying, hospices still provide the vast majority of those services. Close to 50% of organizations that provide that care in the home are hospice providers, CAPC reported.
Rising demand is drawing more interest in palliative care, driven by demographic tailwinds, which are anticipated to propel continued growth. Nevertheless, many patients who could benefit from these services do not receive them — an approximated 6 million nationwide, according to CAPC.
Cost reduction opportunities in palliative care are also attracting interest among payers, providers and policymakers, particularly through reduced hospitalizations and emergency department visits.
But a second challenge is the lack of a standardized palliative care model. A patient receiving palliative care from one provider in one market may get a different set of services than they would elsewhere.
“One of the big challenges is that there are so many different flavors of what palliative care is,” Dr. Andrew Mayo, chief medical officer for St. Croix Hospice, said at the conference. “We don’t have any true one definition of what it looks like in any given care model, and so we’re seeing a lot of different things being implemented in different ways throughout the health care scene.”
A range of medical, psychosocial and behavioral health services can fall within the scope of interdisciplinary palliative care, including advance care planning services, spiritual care and symptom management among others.
Research shows that paying closer attention to palliative care needs during hospital discharge planning could help foster greater continuity.
“For patients hospitalized with life-threatening illnesses and their families, palliative care consultants can provide critical support by providing information about prognosis, ensuring that symptoms are managed, helping to clarify goals of care, and addressing psychosocial and spiritual concerns …” a study published in the Journal of Palliative Medicine indicated. “Gaps in discharge planning not only decrease quality of life for patients, but also translate into lack of support for caregivers. The palliative care population would be expected to benefit from a customized approach to hospital discharge.”
